Pleural mesothelioma: treatment
Treatment for pleural mesothelioma should be combined, as one-component therapy for this disease does not produce positive results. Almost the entire arsenal of anticancer treatments is used in the fight against mesothelioma. In addition to surgery, radiation and chemotherapy, they apply immunotherapy, photodynamic and gene therapy.
Surgical treatment may include:
• Palliative Surgery (Pleurodesis, Drainage);
• Cytoreductive Intervention (Removal Of Part Of The Pleura Or Its Lining);
• Radical Surgery (Extrapleural Pneumonectomy, Ie Removal Of The Lung).
If the patient has a pleural effusion, it is quite life-threatening. Therefore, it must be eliminated. To do this, excess fluid is removed by drainage, ie. the tube is inserted through a surgical incision in the chest. This method will not help if the liquid is very viscous. In addition, after the procedure, it can fill the cavity again. Often, after suctioning all the fluid, doctors inject talc into the tube, which acts as a sealant for two layers of pleura. This closes the pleural cavity and no longer fills the fluid. Such an operation is called pleurodesis.
A pleurectomy involves removal of the maximum possible tumour volume. Usually, the entire parietal pleura and part or all of the visceral pleura are usually removed. Such intervention helps to improve the effectiveness of follow-up anticancer therapy as well as to eliminate the underlying clinical symptoms. Pleurectomy is an option in the early stages of mesothelioma.
Extravascular pneumonectomy is indicated in common tumours. In minimal volume, it involves the removal of the parietal and visceral pleura, the lung, as well as the resection of the pericardium and half of the diaphragm. Such operations are very effective but at the same time difficult, so they are performed only for patients with good functional status. Deaths during radical surgery in the pleural mesothelioma range from 5 to 10%. In addition, many complications are often observed: atrial fibrillation, deep vein thrombosis, paresis of the vocal cords.
Well-demarcated, nodal tumours are much easier to remove and the postoperative period goes without complications. Diffuse-spread mesothelioma requires extensive interventions, and then takes a long time to recover. Non-operative patients (with distant metastases) may undergo a reduction in tumour volume by thoracotomy. If this method is also not available, palliative surgery (bypass, pleurodesis) is performed.
Chemotherapy for pleural mesothelioma may be:
It is prescribed before the operation to stop tumour growth and prevent the development of metastases. NeoChT in combination with surgery and subsequent radiation in many cases allows for very good results, but some doctors oppose this, citing the negative effects of delaying surgery;
adjuvant (postoperative). The results of the operation need to be consolidated. Mesothelioma is resistant to most chemotherapy drugs. The only effective treatment regimen is the combination of cisplatin with pemetrexed or gemcitabine. With it, you can extend the life of the patient for several more months; intrapleural (flushing of the pleural cavity with cisplatin). This method is quite dangerous and has no significant effect on average survival. Only a few cases with high survival rates after intrapleural chemotherapy have been mentioned in the literature.